The 2023 report of the MJA-Lancet Countdown on health and climate change: sustainability needed in Australia's health care sector.

The MJA-Lancet Countdown on health and climate change in Australia was established in 2017 and produced its first national assessment in 2018 and annual updates in 2019, 2020, 2021 and 2022. It examines five broad domains: health hazards, exposures and impacts; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. In this, the sixth report of the MJA-Lancet Countdown, we track progress on an extensive suite of indicators across these five domains, accessing and presenting the latest data and further refining and developing our analyses. Our results highlight the health and economic costs of inaction on health and climate change. A series of major flood events across the four eastern states of Australia in 2022 was the main contributor to insured losses from climate-related catastrophes of $7.168 billion - the highest amount on record. The floods also directly caused 23 deaths and resulted in the displacement of tens of thousands of people. High red meat and processed meat consumption and insufficient consumption of fruit and vegetables accounted for about half of the 87 166 diet-related deaths in Australia in 2021. Correction of this imbalance would both save lives and reduce the heavy carbon footprint associated with meat production. We find signs of progress on health and climate change. Importantly, the Australian Government released Australia's first National Health and Climate Strategy, and the Government of Western Australia is preparing a Health Sector Adaptation Plan. We also find increasing action on, and engagement with, health and climate change at a community level, with the number of electric vehicle sales almost doubling in 2022 compared with 2021, and with a 65% increase in coverage of health and climate change in the media in 2022 compared with 2021. Overall, the urgency of substantial enhancements in Australia's mitigation and adaptation responses to the enormous health and climate change challenge cannot be overstated. Australia's energy system, and its health care sector, currently emit an unreasonable and unjust proportion of greenhouse gases into the atmosphere. As the Lancet Countdown enters its second and most critical phase in the leadup to 2030, the depth and breadth of our assessment of health and climate change will be augmented to increasingly examine Australia in its regional context, and to better measure and track key issues in Australia such as mental health and Aboriginal and Torres Strait Islander health and wellbeing.

Practical cooling interventions for preventing heat strain in indoor factory workers in Thailand.

BACKGROUND: Occupational heat stress, exacerbated by factors such as climate change and insufficient cooling solutions, endangers the health and productivity of workers, especially in low-resource workplaces. OBJECTIVE: To evaluate the effectiveness of two cooling strategies in reducing physiological strain and productivity of piece-rate workers over a 9-h work shift in a southern Thailand sawmill. METHODS: In a crossover randomized control trial design, 12 (33 ± 7 y; 1.58 ± 0.05 m; 51 ± 9 kg; n = 5 females) medically screened sawmill workers were randomly allocated into three groups comprising an established phase change material vest (VEST), an on-site combination cooling oasis (OASIS) (i.e., hydration, cold towels, fans, water dousing), and no cooling (CON) across 3 consecutive workdays. Physiological strain was measured via core temperature telemetry and heart rate monitoring. Productivity was determined by counting the number of pallets of wood sorted, stacked, and stowed each day. RESULTS: Relative to CON, OASIS lowered core temperature by 0.25°C [95% confidence interval = 0.24, 0.25] and heart rate by 7 bpm [6, 9] bpm, compared to 0.17°C [0.17, 0.18] and 10 [9,12] bpm reductions with VEST. It was inconclusive whether productivity was statistically lower in OASIS compared to CON (mean difference [MD] = 2.5 [-0.2, 5.2]), and was not statistically different between VEST and CON (MD = 1.4 [-1.3, 4.1]). CONCLUSIONS: Both OASIS and VEST were effective in reducing physiological strain compared to no cooling. Their effect on productivity requires further investigation, as even small differences between interventions could lead to meaningful disparities in piece-rate worker earnings over time.

Temporal changes in temperature-related mortality in relation to the establishment of the heat-health alert system in Victoria, Australia.

Extreme heat alerts are the most common form of weather forecasting services used in Australia, yet very limited studies have documented their effectiveness in improving health outcomes. This study aimed to examine the temporal changes in temperature-related mortality in relation to the activation of the heat-health alert and response system (HARS) in the State of Victoria, Australia. We examined the relationship between temperatures and mortality using quasi-Poisson regression and the distributed lag non-linear model (dlnm) and compared the temperature-mortality association between the two periods: period 1- prior-HARS (1992-2009) and period 2- post-HARS (2010-2019). Since the HARS heavily weights heatwave effects, we also compared the main effects of heatwave events between the two periods. The heatwaves were defined for three levels, including 3 consecutive days at 97th, 98th, and 99th percentiles. We also controlled the potential confounding effect of seasonality by including a natural cubic B-spline of the day of the year with equally spaced knots and 8 degrees of freedom per year. The exposure-response curve reveals the temperature mortality was reduced in period 2 in comparison with period 1. The relative risk ratios (RRR) of Period 2 over Period 1 were all less than one and gradually decreased from 0.86 (95% CI, 0.72-1.03) to 0.64 (95% CI, 0.33-1.22), and the differences in attributable risk percent increased from 13.2 to 25.3%. The reduction in the risk of heatwave-related deaths decreased by 3.4% (RRp1 1.068, 95% CI, 1.024-1.112 versus RRp2 1.034, 95% CI, 0.986-1.082) and 10% (RRp1 1.16, 95% CI, 1.10-1.22 versus RRp2 1.06, 95% CI, 1.002-1.119) for all groups of people. The study indicated a decrease in heat-related mortality following the operation of HARS in Victoria under extreme heat and high-intensity heatwaves conditions. Further studies could investigate the extent of changes in mortality among populations of differing socio-economic groups during the operation of the heat-health alert system.

Wearing masks as a protective measure for children against traffic-related air pollution: A comparison of perceptions between school children and their caregivers in Ho Chi Minh City, Vietnam.

BACKGROUND: Traffic-related air pollution (TRAP) problems are unlikely to be solved in the short term, making it imperative to educate children on protective measures to mitigate the negative impact on their health. Children and their caregivers may hold differing views on wearing a face mask as a safeguard against air pollution. While many studies have focused on predicting children's health-protective behaviours against air pollution, few have explored the differences in perceptions between children and their caregivers. OBJECTIVES: To examine this, we conducted a study that compared the health beliefs of two generations and evaluated the factors that influence the use of masks by children to reduce air pollution exposure. METHODS: The study was conducted in 24 secondary schools and involved 8420 children aged 13-14 and their caregivers. We used a Health Belief Model (HBM)-based instrument containing 17-item self-administered health beliefs questionnaires to gather data. The results were analysed using hierarchical logistic regression to determine the probability of children frequently wearing masks to protect against TRAP. RESULTS: Our study showed both children and caregivers recognised that several factors could influence mask-wearing among children: discomfort or difficulty breathing while wearing a mask and forgetting to bring a mask when going outside; perceived threats of the poor quality of air and children's respiratory health problems; and cues to mask use (i.e., seeing most of their friends wearing facemasks and ease of finding masks in local stores). However, only children were significantly concerned with public perception of their appearance while wearing a mask. Females were more likely to wear masks, and caregivers with higher levels of education were more likely to encourage their children to wear masks. Children who commuted to schools by walking, biking, or motorbiking were also more accepting of mask-wearing than those who travelled by car or bus. CONCLUSIONS: Children and their caregivers hold different perceptions of wearing masks to protect against air pollution. Children are more susceptible to social judgements regarding their appearance when wearing a mask.

Burden of asthma-like symptoms and a lack of recognition of asthma in Vietnamese children.

OBJECTIVE: Lack of recognition of asthma in childhood results in unmet asthma treatment needs and leads to the risk of sub-optimal respiratory health. The present study assessed the prevalence of asthmatic under-recognition in middle school children in Vietnam. METHODS: We conducted a school-based survey among 15,112 Vietnamese children. Most of them are aged from 13 to 14. Schools and students were recruited using multi-stage sampling. Respiratory symptoms were collected via self-report using a standardized tool from the International Study of Asthma and Allergies in Childhood. Under-recognition of asthma was defined as a presence of at least one asthma-like symptom but a negative response to having ever asthma. Associations were investigated using logistic regression. RESULTS: Prevalence of asthma-like symptoms was 27.3% and prevalence of physician-diagnosed asthma was 8.5%. Over 80% of symptomatic children were not diagnosed with asthma. Under-recognition of asthma was found more in girls (adjusted odds ratio; aOR = 1.75; 95%CI: 1.54 to 1.98). CONCLUSIONS: Asthma is significantly under-recognized in Vietnamese middle-school children. Urgent action is required to improve the recognition of asthma in Vietnam.

Heat, heatwaves, and ambulance service use: a systematic review and meta-analysis of epidemiological evidence.

Ambulance data has been reported to be a sensitive indicator of health service use during hot days, but there is no comprehensive summary of the quantitative association between heat and ambulance dispatches. We conducted a systematic review and meta-analysis to retrieve and synthesise evidence published up to 31 August 2022 about the association between heat, prolonged heat (i.e. heatwaves), and the risk of ambulance dispatches. We initially identified 3628 peer-reviewed papers and included 48 papers which satisfied the inclusion criteria. The meta-analyses showed that, for each 5 °C increase in mean temperature, the risk of ambulance dispatches for all causes and for cardiovascular diseases increased by 7% (95% confidence interval (CI): 5%, 10%) and 2% (95% CI: 1%, 3%), respectively, but not for respiratory diseases. The risk of ambulance dispatches increased by 6% (95% CI: 4%, 7%), 7% (95% CI: 5%, 9%), and 18% (95% CI: 12%, 23%) under low-intensity, severe, and extreme heatwaves, respectively. We observed two potential sources of bias in the existing literature: (1) bias in temperature exposure measurement; and (2) bias in the ascertainment of ambulance dispatch causes. This review suggests that heat exposure is associated with an increased risk of ambulance dispatches, and there is a dose-response relationship between heatwave intensity and the risk of ambulance dispatches. For future studies assessing the heat-ambulance association, we recommend that (1) using data on spatially refined gridded temperature that is either very well interpolated or derived from satellite imaging may be an alternative to reduce exposure measurement bias; and (2) linking ambulance data with hospital admission data can be useful to improve health outcome classification.

Relationships between short-term ambient temperature exposure and kidney disease hospitalizations in the warm season in Vietnam: A case-crossover study.

BACKGROUND: Under a warming climate, adverse health effects of heat are an increasing concern. We evaluated associations between short-term ambient temperature exposure and hospital admission for kidney disease in Vietnam. METHODS: We linked province-level meteorologic data with admission data from 14 province-level hospitals (2003-2015). We used a case-crossover design to evaluate associations between daily ambient temperature metrics (mean, maximum, and minimum temperature and mean heat index) and risk of hospitalization for four kidney disease subtypes: glomerular diseases, renal tubulo-interstitial diseases, chronic kidney disease, and urolithiasis, including lagged (≤lag 14 days) and cumulative (≤lag 0-6 days) associations, during the warm season. We also evaluated independent associations with extreme heat days (defined as days with daily maximum temperature >95th percentile of the provincial daily maximum temperature distribution). Akaike's information criterion and patterns of risk estimates across cumulative exposure time windows and single-day lags informed our selection of final models. RESULTS: We included 58,330 hospital admissions during the warm season. Daily mean temperature averaged over the same day and the previous six days (lag 0-6 days) was associated with risk of hospitalization for each kidney disease outcome with odds ratios (per 1 °C increase in daily mean temperature) of 1.07 (95% confidence interval [CI]: 0.99, 1.16) for glomerular diseases, 1.06 (95% CI: 0.96, 1.17) for renal tubulo-interstitial diseases, 1.12 (95% CI: 1.00, 1.24) for chronic kidney disease, and 1.09 (95% CI: 1.02, 1.16) for urolithiasis. We found no additional independent associations with extreme heat. Results for the four temperature metrics were similar. CONCLUSIONS: High ambient temperature was associated with increased risk of hospitalization for each kidney disease subtype, with the most convincing associations for chronic kidney disease and urolithiasis. Further laboratory and epidemiologic research is needed to confirm the findings and disentangle the underlying mechanisms.

Avoidable burden of stomach cancer and potential gains in healthy life years from gradual reductions in salt consumption in Vietnam, 2019-2030: a modelling study.

OBJECTIVE: Excess salt consumption is causally linked with stomach cancer, and salt intake among adults in Vietnam is about twice the recommended levels. The aim of this study was to quantify the future burden of stomach cancer that could be avoided from population-wide salt reduction in Vietnam. DESIGN: A dynamic simulation model was developed to quantify the impacts of achieving the 2018 National Vietnam Health Program (8 g/d by 2025 and 7 g/d by 2030) and the WHO (5 g/d) salt reduction policy targets. Data on salt consumption were obtained from the Vietnam 2015 WHO STEPS survey. Health outcomes were estimated over 6-year (2019-2025), 11-year (2019-2030) and lifetime horizons. We conducted one-way and probabilistic sensitivity analyses. SETTING: Vietnam. PARTICIPANTS: All adults aged ≥ 25 years (61 million people, 48·4 % men) alive in 2019. RESULTS: Achieving the 2025 and 2030 national salt targets could result in 3400 and 7200 fewer incident cases of stomach cancer, respectively, and avert 1900 and 4800 stomach cancer deaths, respectively. Achieving the WHO target by 2030 could prevent 8400 incident cases and 5900 deaths from stomach cancer. Over the lifespan, this translated to 344 660 (8 g/d), 411 060 (7 g/d) and 493 633 (5 g/d) health-adjusted life years gained, respectively. CONCLUSIONS: A sizeable burden of stomach cancer could be avoided, with gains in healthy life years if national and WHO salt targets were attained. Our findings provide impetus for policy makers in Vietnam and Asia to intensify salt reduction strategies to combat stomach cancer and mitigate pressure on the health systems.

Natural dynamics and residues of pymetrozine for typical rice-growing areas of China.

Pymetrozine has replaced toxic organophosphate pesticides previously used for controlling pests of rice crops in China. Existing data on its environmental behavior are usually related to studies on artificial plots that do not adequately address the natural dynamics and residues in actual field conditions. Therefore, studies under field conditions were carried out to investigate the natural dynamics and residues of pymetrozine in two typical rice-growing areas in China - Hunan and Guangxi provinces. Samples of paddy soil and water were collected in relation to spraying events in the study areas. The quick, easy, cheap, effective, rugged and safe (QuEChERS) method was used to extract pymetrozine residues from the samples by a Waters ACQUITY UPLC (Milford, MA, USA) system interfaced with a triple-quadrupole mass spectrometer (Xevo TQ-D, Waters Corp., USA). The initial deposition of pymetrozine in paddy soils was higher than in paddy waters in both areas. The decay of pymetrozine followed an exponential trend consistent with the first order kinetics. The half-life of pymetrozine in paddy water was determined to be 3.0 and 3.8 days, whereas the half-life in soil was 3.8 and 3.5 days in the Guangxi and Hunan samples, respectively. The decline rates of pymetrozine in paddy soil and paddy water in this field study were faster than those conducted under non-field conditions reported in previous studies. Compared to other pesticides used in China as reported in previous studies, the environmental persistence of pymetrozine in both paddy water and soils in Guangxi and Hunan provinces is very low. This has important implications for the use of pymetrozine in agricultural systems globally.

The relationship between team dynamics with healthcare coordination and clinical work satisfaction among Commune Health Workers: A Bayesian model averaging study.

OBJECTIVE: To determine the relationship between team dynamics with healthcare coordination and clinical job satisfaction of the community health workers (CHWs). METHODS: A cross-sectional study was conducted among 133 health workers (including doctors, nurses, or midwives) at 21 Commune Health Cent in Quoc Oai District, Vietnam, from July 2015 to May 2017. A self-administered questionnaire consisting of 5-Likert items regarding team dynamics and healthcare coordination clinical work satisfaction was utilised. Descriptive statistics and correlation matrix were applied for seven factors of team dynamic, clinical work satisfaction, and patient care coordination queried by primary care providers. Bayesian model averaging (BMA) was used to identify the predictors of the level of team dynamics and healthcare coordination. RESULTS: The mean score of overall team dynamics among the study participants was 4.08. Clinical work satisfaction and patient care coordination scores among resident physicians were higher than those of attending clinicians; however, the differences were not statistically significant. The results of BMA analysis indicated that team dynamics significantly associated with clinical work satisfaction, and it explains 9% of the total variance in clinical work satisfaction. Team dynamics level was also positively associated with patient care coordination. Patient care coordination was not a significant mediator between team dynamics and clinical work satisfaction. CONCLUSION: Team dynamics is a potential contributor to improving patient care coordination and clinical job satisfaction of CHWs. As no significant correlation between patient care coordination and clinical job satisfaction was observed, to improve team performance, providing conditions that facilitate team building and teamwork should be conducted for CHWs in CHCs.

A novel signature predicts recurrence risk and therapeutic response in breast cancer patients.

Acetylserotonin O-methyltransferase (ASMT) is a key enzyme in the synthesis of melatonin. Although melatonin has been shown to exhibit anticancer activity and prevents endocrine resistance in breast cancer, the role of ASMT in breast cancer progression remains unclear. In this retrospective study, we analyzed gene expression profiles in 27 data sets on 7244 patients from 11 countries. We found that ASMT expression was significantly reduced in breast cancer tumors relative to healthy tissue. Among breast cancer patients, those with higher levels of ASMT expression had better relapse-free survival outcomes and longer metastasis-free survival times. Following treatment with tamoxifen, patients with greater ASMT expression experienced longer periods before relapse or distance recurrence. Motivated by these results, we devised an ASMT gene signature that can correctly identify low-risk cases with a sensitivity and specificity of 0.997 and 0.916, respectively. This signature was robustly validated using 23 independent breast cancer mRNA array data sets from different platforms (consisting of 5800 patients) and an RNAseq data set from TCGA (comprising 1096 patients). Intriguingly, patients who are classified as high-risk by the signature benefit from adjuvant chemotherapy, and those with grade II tumors who are classified as low-risk exhibit improved overall survival and distance relapse-free outcomes following endocrine therapy. Together, our findings more clearly elucidate the roles of ASMT, provide strategies for improving the efficacy of tamoxifen treatment and help to identify those patients who may maximally benefit from adjuvant or endocrine therapies.

Relationship between flood severity and risk of hospitalisation in the Mekong River Delta of Vietnam.

OBJECTIVE: To examine the relationship between flood severity and risk of hospitalisation in the Vietnam Mekong River Delta (MRD). METHODS: We obtained data on hospitalisations and hydro-meteorological factors during 2011-2014 for seven MRD provinces. We classified each day into a flood-season exposure period: the 2011 extreme annual flood (EAF); 2012-2014 routine annual floods (RAF); dry season and non-flood wet season (reference period). We used province-specific Poisson regression models to calculate hospitalisation incidence rate ratios (IRRs). We pooled IRRs across provinces using random-effects meta-analysis. RESULTS: During the EAF, non-external cause hospitalisations increased 7.2% (95% CI 3.2% to 11.4%); infectious disease hospitalisations increased 16.4% (4.3% to 29.8%) and respiratory disease hospitalisations increased 25.5% (15.5% to 36.4%). During the RAF, respiratory disease hospitalisations increased 8.2% (3.2% to 13.5%). During the dry season, hospitalisations decreased for non-external causes and for each specific cause except injuries. CONCLUSIONS: We observed a gradient of decreasing risk of hospitalisation from EAF to RAF/non-flood wet season to dry season. Adaptation measures should be strengthened to prepare for the increased probability of more frequent extreme floods in the future, driven by climate change.

Impact of temperature on hospital admission for acute lower respiratory infection (ALRI) among pre-school children in Ho Chi Minh City, Vietnam.

Changes in ambient temperature have been reported as an important risk factor for respiratory diseases among pre-school children. However, there have been few studies so far on the effects of temperature on children respiratory health in developing countries including Vietnam. This study examined the impact of short-term changes in ambient temperature on hospital admissions for acute lower respiratory infection (ALRI) among children aged less than 5 years old in Ho Chi Minh City (HCMC), Vietnam. Data on daily hospital admissions from 2013 to 2017 were collected from two large paediatric hospitals of the city. Daily meteorological data of the same period were also collected. Time series analysis was performed to evaluate the association between risk of hospitalisations and temperatures categorised by seasons, age, and causes. We found that a 1 °C increase in maximum temperature was associated with 4.2 and 3.4% increase in hospital admission for ALRI among children 3-5 years old during the dry season and the rainy season, respectively. Surprisingly, in the rainy season, a rise of 1°C diurnal temperature range (DTR) was significantly associated with a decrease from 2.0 to 2.5% risk of hospitalisation for ALRI among children <3 years old. These findings suggested that although high temperature is a risk factor for hospital admissions among children in general, other modifiable factors such as age, exposure time, air conditioning usage, wearing protective clothing, socioeconomic status, and behaviour may influence the overall effect of high temperature on hospital admissions of children <5 years old in HCMC. The findings of this study have provided evidence for building public health policies aimed at preventing and minimizing the adverse health effects of temperature on children in HCMC.

Impacts of helmet law on the changes in potential years of life lost due to traffic injury: a multiple-province evaluation in Vietnam.

INTRODUCTION: This study aimed to evaluate the impact of the helmet law on the changes in potential years of life lost (PYLL) due to traffic mortality and to examine modification effects of socioeconomic factors on the impacts in Vietnam. METHODS: We applied an interrupted time series design using the Bayesian framework to estimate the impact of the law at the provincial level. Then, we used random effects meta-analysis to estimate the impact of the law at the country level and to examine the modification effects of socioeconomic factors. RESULTS: The results indicate that the impacts varied among the provinces. These impacts could be classified by four main groups comprising positive impact, and positive impact without sustainability, possible positive impact, negative or inconsistent impact. For the country-level impact, the results reveal a significantly consistent change in monthly PYLLs at the level of 18 per 100 000 persons, and the post-trend was stable without significant change. The results of meta-regression show that 1 unit increase in the population density (persons/km2), migration rate (%) and income (×1000 dong) are non-significantly associated with increases of PYLLs at 1.3, 27 and 27 per 100 000 person-months, respectively, whereas 1% increase in literacy associated with a decrease of PYLL at 44 per 100 000 person-months. DISCUSSION: Further studies should be warranted to provide a comprehensive evaluation of the law implementation, including its acceptability, adoption, appropriateness, feasibility, cost-effectiveness and sustainability.

Temporal relationships between climate variables and hand-foot-mouth disease: a multi-province study in the Mekong Delta Region, Vietnam.

Hand-foot-mouth disease (HFMD) is an emerging infectious disease that affects thousands of children every year in Vietnam, especially in the Mekong Delta Region (MDR). This study aims to analyse both provincial and regional level effects of climate factors on HFMD in multiple provinces of this high-risk region. Generalized linear models were used to analyse the daily effects of average temperature, humidity and rainfall on HFMD incidence in each province (provincial-level effects), and random-effect meta-analysis was used to estimate the pooled effect size of these climate-HFMD associations (regional-level effects). Daily effects of the climate factors on HFMD were found at both provincial level and regional level. At provincial level, temperature and humidity had statistically significant positive associations with HFMD while rainfall had both positive and negative associations with HFMD at different lag days. At regional level, temperature and humidity were positively associated with HFMD at lag 0 days (1.7%; 95%CI 0.1%-3.3%) and at lag 3 days (0.3%; 95%CI 0.1%-0.5%), respectively. In contrast, rainfall was found to be negatively associated with HFMD at lag 5 days (- 0.3%; 95%CI - 0.4% to - 0.1%). Heterogeneities of the effects of rainfall on HFMD were found to be higher than those of temperature or humidity. This is the first study to address the climate-HFMD associations in multiple provinces of the MDR. These associations draw attention to climate-related health issues and will help in developing an environment-based early warning system for HFMD prevention and control.

Spatial patterns of health vulnerability to heatwaves in Vietnam.

The increasing frequency and intensity of heat events have weighty impacts on public health in Vietnam, but their effects vary across regions. In this study, we have applied a vulnerability assessment framework (VAF) to systematically assess the spatial pattern of health vulnerability to heatwaves in Vietnam. The VAF was computed as the function of three dimensions: exposure, sensitivity, and adaptive capacity, with the indicators for each dimension derived from the relevant literature, consultation with experts, and available data. An analytic hierarchy process (AHP) was used to determine the weight of indicators. Each province in Vietnam's vulnerability to the health impacts of heatwaves was evaluated by applying the vulnerability index, computed using 13 indicators (sensitivity index, 9; adaptive capacity index, 3; and exposure index, 1). As a result of this analysis, this study has identified heatwave vulnerability 'hotspots', primarily in the Southeast, Central Highlands, and South Central Coast of Vietnam. However, these hotspots are not necessarily the same as the area most vulnerable to climate change, because some areas that are more sensitive to heatwaves may have a higher capacity to adapt to them due to a host of factors including their population characteristics (e.g. rates of the elderly or children), socio-economic and geographical conditions, and the availability of air-conditioners. This kind of information, provided by the vulnerability index framework, allows policymakers to determine how to more efficiently allocate resources and devise appropriate interventions to minimise the impact of heatwaves with strategies tailored to each region of Vietnam.

The effectiveness of workplace health promotion in low- and middle-income countries.

Although many literature reviews synthesize literature regarding workplace health promotion (WHP) interventions, systematic reviews on the effectiveness of and factors influencing the operation of WHP activities in low- and middle-income countries (LMIC) are scarce. Therefore, we systematically reviewed evaluation studies to examine the effectiveness and factors related to the implementation of WHP programmes in LMIC. Twenty-six peer-reviewed and grey evaluation studies, published before November 2017, were included from electronic databases (PubMed, The Cochrane Library, PsycINFO, EMBASE and Web of Science) and manual searching. The results revealed that WHP intervention in LMIC was effective in reducing health risks in a wide range of industries and settings, including in resource-poor contexts such as small enterprises and the manufacturing industry. The main factors positively influencing the effectiveness of the intervention are long intervention time period, and needs-based and active intervention strategies. In addition, commitment from workplace leaders, the involvement of workers and support from authorities and professionals are factors contributing to a successful WHP programme. However, the evidence regarding the effectiveness of WHP in LMIC regarding the health outcomes and business productivity is inconclusive due to the several remaining methodological limitations. Future developments of more rigorous methods of evaluating the effectiveness of WHP activities should be addressed to produce higher-quality evidence that would inform future practice.

Comparative evaluation of chlorpyrifos exposure estimates from whole-body dermal dosimetry and urinary trichloro-2-pyridinol (TCP) methods.

Chlorpyrifos is one of the most widely used organophosphate pesticides and has a record of adverse effects on applicators. Assessment of exposure to chlorpyrifos based on its urinary metabolite, 3,5,6-trichloro-2-pyridinol (TCP), is considered as the most accurate. However, urine sampling can be difficult, and the laboratory analytical procedures involved are complex and expensive. A simpler approach for assessing pesticide exposure among applicators is the whole-body dermal dosimetry method, but this needs validation. The objective of this study was to compare chlorpyrifos exposure estimates obtained separately with the urinary TCP and the whole-body dermal dosimetry methods from applicators. Exposure estimates from the whole-body dermal dosimetry method (5-29 µg/kg/day) showed less variation than those from the urinary TCP method (1-71 µg/kg/day), but both were in close agreement at the mean level (16 µg/kg/day and 15 µg/kg/day, respectively). The whole-body dermal dosimetry method is therefore valid for providing estimates of the typical levels of pesticide exposure among applicators in situations where the urinary TCP method cannot be applied.

Association between salinity and hospital admission for hypertension: an ecological case-control study in the Mekong Delta Region in Vietnam.

Background: Drinking water in the Mekong Delta Region (MDR) is highly vulnerable to salinity intrusion and this problem is expected to increase with the projected climate change and sea level rise. Despite this, research on health effects of saline contaminated water is scarce in this region. This study examines the risk of hospital admission for hypertension in salinity-affected areas of the MDR. Methods: Cases and controls were obtained from national/provincial hospital admission records for 2013. The cases were adult patients whom hypertension (ICD10-code: I10-I15) was primary diagnosis for admission. Of the 13 provinces in the MDR, we identified seven as 'salinity exposed' and the remaining as 'non-exposed' areas. A multi-level logistic regression model was used to examine the association between salinity exposure and hypertension outcome. Results: Of the total 573 650 hospital admissions, 22 382 (~3.9%) were hypertensive cases. The multi-level logistic model combining both individual and ecological factors showed a 9% increase in risk (95% CI: 3-14%) of hypertension admission among individuals in exposed areas compared to those in non-exposed areas. Conclusion: In order to develop and promote appropriate adaptation strategies, further research is recommended to identify the salt exposure pathways and consumption behaviours in the salinity exposed areas.

Can wastewater-based epidemiology be used to evaluate the health impact of temperature? - An exploratory study in an Australian population.

Ambient temperature is known to have impact on population health but assessing its impact by the traditional cohort approach is resource intensive. Wastewater-based epidemiology (WBE) could be an alternative for the traditional approach. This study was to provide the first evaluation to see if WBE can be used to assess the impact of temperature exposure to a population in South East Queensland, Australia using selected pharmaceuticals and personal care products (PPCPs) as biomarkers. Daily loads of eight PPCPs in wastewater collected from a wastewater treatment plant were measured from February 2011 to June 2012. Corresponding daily weather data were obtained from the closest weather station. Missing data of PPCPs were handled using the multiple imputation (MI) method, then we used a one-way between-groups analysis of variance to examine the seasonal effect on daily variation of PPCPs by seasons. Finally, an MI estimate was performed to evaluate the continuous relationship between daily average temperature and each multiply-imputed PPCP using time-series regression analysis. The results indicated that an increase of 1°C in average temperature associated with decrease at 1.3g/d (95% CI: -2.2 to (-0.4), p<0.05) for atenolol, increase at 36.5g/d (95% CI: 25.2-47.8, p<0.01) for acesulfame, and increase at 0.8g/d (95% CI: 0.02-1.55, p=0.05) for naproxen. No significant association was observed between temperature and the remaining PPCPs, comprising: caffeine, carbamazepine, codeine, hydrochlorothiazide, and salicylic acid. The findings suggested that consumption of sweetened drinks, risk of worsening cardiovascular conditions and pains are associated with variation in ambient temperature. WBE can thus be used as a complementary method to traditional cohort studies in epidemiological evaluation of the association between environmental factors and health outcomes provided that specific biomarkers of such health outcomes can be identified.